Cardiologist Dr Miles Williams explains why he has laid a formal complaint about the New Zealand Medical Association’s ‘deceptive and misleading’ rejection of the right for terminally ill people to end their lives.
It would be reasonable to believe that the care of a dying person whether in hospital or hospice, a rest home, or in their own home, would be a structured and consistent process. Symptoms would be methodically analysed and addressed as they emerged. Sadly, in my experience as a hospital physician and cardiologist for over 30 years this has not been the case.
I have seen patients exist in a semi-comatose state for days while their weary but determined family members stand by.
I have seen patients whose medications were clearly insufficient to control their pain or breathlessness.
I have seen terminally ill patients close to death whose pain relief was reversed because of concern that the medication was too strong, followed by predictably distressing results.
I have seen patients exist in a semi-comatose state for days while their weary but determined family members stand by.
I used to believe that assisted dying legislation would not be necessary. I used to believe that there would always be a kindly knowing physician who would quietly intervene when needed. Now I know that this is not the case and can never be the case unless legislation comes into force that will enable such care to occur. That legislation is the End of Life Choice Act, but the true nature of the Act has been obscured by the widespread use of deliberate distortion and deception similar to that used by conspiracy theorists.
Conspiracy theories combine a little fact with a lot of conjecture, falsehood and imaginative misrepresentation. They are constructed to appeal to anxieties.
The End of Life Choice Act and the forthcoming referendum has been subjected to the same treatment, and strangely, some of it has come from a wholly unexpected source … the New Zealand Medical Association:
“The medical practitioner entrusted to make this assessment does not require any previous contact with the person and does not need to be qualified in the specialty relevant to the person’s condition. It is not clear if this criteria would be met for a person that declines (or cannot afford) treatment or services without which they would be likely to die within 6 months….. It is unclear how “advanced state” will be defined. It is unclear whether decline would be considered to be irreversible in circumstances where it is due to a person being unable to access (or afford) appropriate care or services. It is not clear whether a person in a steady state of physical disability such as a quadriplegic would meet this criterion.”
This is an excerpt from the Medical Association “Fact Sheet” on End of Life Choice. It all very sounds very convincing but is in fact either misleading or completely false. It does not accurately reflect the contents of the End of Life Choice Act. A complaint has been made to the Medical Council of New Zealand regarding the deceptive nature of this article and the Medical Council is considering this.
It is tempting to view the argument of those who oppose End of Life Choice as any person having such a damn hard time of dying is perfectly entitled to end it all by starving themselves to death, or by using some other means (possibly violent) of their choosing. All they need is a bit of True Grit.
Why are professionals from all walks of life, including doctors and lawyers, prepared to misrepresent a document that has been subjected to intense scrutiny by parliamentary legal advisers, specialist doctors with extensive experience of Assisted Dying and Members of Parliament who have passed this into Law?
It is tempting to view the argument of those who oppose end of life choice as any person having such a damn hard time of dying is perfectly entitled to end it all by starving themselves to death, or by using some other means (possibly violent) of their choosing. All they need is a bit of True Grit. Such a view would argue that opponents (to end of life choice) would consider this as an infinitely more desirable path than a doctor kneeling down beside the patient and saying, “I can help you”.
What the opponents of end of life choice seem to be saying is that an individual should suffer until death shakes that suffering off with a flick of its wrist.
In the palliative care setting one often hears the comment that death should be “neither hastened nor prolonged”. This implies that the caregiver has some form of divine insight into the course of the illness and the date of death that is unavailable to anybody else.
What possible reason can there be that drives some doctors to say that living with suffering until released by death, or by taking one’s own life, is preferable to being assisted to die?
Doctors are trained to think logically rationally and scientifically. They are taught the value of evidence-based studies. Countless patients with heart disease, blood disorders, gastrointestinal conditions and joint disorders and many other conditions have benefited from this scientific discipline.
But doctors are also taught to consider the patient as an individual. No amount of training in evidence-based medicine will help a physician determine whether they are dealing with an unusual person or an unusual condition, or indeed both. Instead it is the humanistic attributes such as patience, empathy, altruism, and commitment which allow the true identity of a condition to be unmasked and the most appropriate treatment commenced.
The successful practice of medicine is a combination of science, humanism, ethical considerations, and trust.
The ethics of assisted dying are clear. There are reasoned arguments that show that it is ethical for a doctor to assist a dying person to die. They all reflect the essence of the 3rd Physician Pledge of the World Medical Association Declaration of Geneva (2017) which states “I will respect the autonomy and dignity of my patient”.
The New Zealand Medical Association states that euthanasia is unethical, and its persistent insistence that assisted dying is unethical reflects an increasingly isolated position. It is not supported by the World Medical Association which removed it from their position statement on Euthanasia in 2019. It is also inconsistent with New Zealand Medical Association’s own statement on the ethics of abortion, part of which reads “Rather than an absolute, dichotomous, rights-based “right to life” versus “right to choose” lens to view abortion, we suggest a pragmatic alternative…”
To dismiss a patient’s wishes and requests on the basis that you know better than they what is good for them, is paternalistic and condescending, and ultimately reflects the doctor’s own insecurities.
So who is right?
From my perspective a physician has a professional obligation to place the wellbeing and rights of patients at the centre of their professional practice. To dismiss a patient’s wishes and requests on the basis that you know better than they what is good for them, is paternalistic and condescending, and ultimately reflects the doctor’s own insecurities.
The End of Life Choice movement can be summarised as follows:
1) This is not a life and death issue. It is a dying and death issue.
2) This is not an Act that gives doctors the right to take away life. It is an Act that gives doctors the right to assist dying people to die.
3) This is not a movement initiated by doctors or governments. This is a global movement instigated by ordinary people facing personal tragedy.
4) This is not experimental legislation. This is legislation similar (and stricter) to that available to millions of people around the world (and no country with this legislation has ever seen fit to reverse it).
5) There is no evidence of deterioration in doctor patient relationships (in fact they are enhanced), there is no evidence that the vulnerable or disabled are at risk, there is no evidence of coercion and there is no evidence of normalisation of suicide or increase in suicide rates.
Last year, I attended the funeral of a friend who had died from cancer. He had wanted to die at home and friends and family had worked together in shifts to care for him. All the usual services had been available to them. Yet on the day of the funeral the survivors looked shellshocked, traumatised and defeated. The effects of the harrowing and exhausting experience were etched on their faces.
It need not have been like that.
The truly vulnerable are those who are truly dying with unbearable suffering and who are refused the help that they request on the grounds that their suffering is necessary and will end at the appointed time.
